title: [Low-titer cold agglutinin disease following Salmonella gastroenteritis].
abstract: We encountered a patient with cold agglutinin disease (CAD) that worsened after Salmonella gastroenteritis. A 52-year-old male complained pain in the left fingers with cyanosis and was admitted in a local hospital. After treatment for ischemia, he demonstrated diarrhea with fever. Because of progressive anemia, he was referred to our hospital. Salmonella gastroenteritis was diagnosed based on the results of microbiological examination. Severe hemolysis was noted at admission, and Coombs test was positive (IgG-, C3d+). Cold agglutinin titer was elevated (x256). There were no findings of malignancy or infection demonstrating CA. A diagnosis of CAD with Salmonella gastroenteritis was made. Because spherocytosis was noted during admission, we measured the mean channel fluorescence (MCF) of eosin-5-maleimide (EMA) in erythrocytes from patients. MCF of EMA of the patient's erythrocytes was similar to that of normal subjects. Therefore, we concluded that coexisting hereditary spherocytosis was unlikely. We also examined the in vitro hemolytic effect of Salmonella infection on his blood and on blood from normal subjects. Treatment with Salmonella enteritidis isolated from this patient was found to induce hemolysis in the patient's blood, but not in blood from a normal subject. Moreover, treatment with Salmonella increased the titer of cold agglutinin in vitro. These data suggested that Salmonella infection might worsen hemolysis in CAD.
authors.affiliation: Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital.
authors.forename: Ken-Ichiro
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Tamae
authors.initials: T
authors.lastname: Hamaki
authors.forename: Akira
authors.initials: A
authors.lastname: Ohwada
authors.forename: Junji
authors.initials: J
authors.lastname: Tomiyama
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sakuma
authors.forename: Yoko
authors.initials: Y
authors.lastname: Mizuta
authors.forename: Akihiko
authors.initials: A
authors.lastname: Moriyama
authors.forename: Emi
authors.initials: E
authors.lastname: Yamamoto
authors.forename: Itsuo
authors.initials: I
authors.lastname: Akiya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
mesh_terms: D000743:Anemia, Hemolytic / Q000209:etiology; D000744:Anemia, Hemolytic, Autoimmune / Q000209:etiology*; D004801:Eosine Yellowish-(YS) / Q000031:analogs & derivatives; D005759:Gastroenteritis / Q000150:complications* / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012480:Salmonella Infections
chemical_list: C033531:eosin maleimide; D004801:Eosine Yellowish-(YS)